医疗费用持续增长机制--基于历史数据和田野资料的分析  

The Source of Constantly Rising Health Care Costs—An Analysis Based on Historical Data and Field Materials

作　　者：刘军强[1] 刘凯[2] 曾益[3] 

机构地区：[1]中山大学中国公共管理研究中心、政治与公共事务管理学院,广州510275 [2]中国人民大学劳动人事学院社会保障系,北京100872 [3]中南财经政法大学公共管理学院,武汉430073

出　　处：《中国社会科学》2015年第8期104-125,206-207,共22页Social Sciences in China

摘　　要：中国已顺利实现医疗保险的全民覆盖,这为解决医疗这一世界性难题奠定了良好的基础。然而,全民医保的三大支柱(职工医保、居民医保、新农合)正面临日益严峻的支付压力。基于过去25年医院住院和门诊数据,将费用增长分解为平均费用和服务使用率。平均费用在1988年至1999年间是住院费用增长的主要动力;从2000年至今,平均费用和使用率共同推动了住院费用的上涨。从1988年至2002年,平均费用是门诊费用增长的主要动力;从2003年起,价格和服务使用率共同推动门诊费用增长。根据对河南、四川两省70位医保政策相关者的访谈,发现目前医保部门控费工具箱内的六种工具并不总是有效。在医方垄断信息优势、患者因医保而对价格敏感度下降的情况下,医患之间的"共谋"使得过度医疗问题日益严重。通过描绘患者、供方、医保三者间的勾连与矛盾,可以展现理性设计的医保第三方购买机制在现实世界中的扭曲和低效。China has successfully achieved universal health coverage,thus laying a sound foundation for the resolution of worldwide health care problems.However,the three major pillars of universal health coverage(employee health insurance,resident health insurance and the new rural cooperative medical system) are under ever greater pressure from costs.On the basis of data on inpatient and outpatient services from hospitals in the past 25 years,we divide cost increases into average costs and service usage rates.Average costs were the main driver of the increase in hospitalization costs from1988 to 1999,but from 2000 on,average costs and the service usage rate were jointly responsible for the increase in hospitalization costs.From 1988 to 2002,average costs were the major driver of increased outpatient costs,but from 2003 on,prices and service usage rates were the joint drivers of increased outpatient costs.Interviews with seventy people connected with medical insurance policy in Henan and Sichuan showed that the six tools in the cost-control toolbox of medical insurance departments are not always effective at present.Given that.hospitals have the advantage of a monopoly on information and patients have become less sensitive to prices thanks to medical insurance,the 'conspiracy' between hospitals and patients is worsening the problem of excessive medical treatment.Depiction of the interconnections and conflicts among patients,suppliers and medical insurance can reveal the distortions and inefficiencies in the rational design of mechanisms for third party purchase of medical insurance in reality.

关 键 词：医疗费用 财务可持续性 医保监管 过度医疗 

分 类 号：F842.67[经济管理—保险] R197.1[医药卫生—卫生事业管理]